If this is your first visit, be sure to
check out the FAQ by clicking the
link above. You may have to register
before you can post: click the register link above to proceed. To start viewing messages,
select the forum that you want to visit from the selection below.

Private or public care

Hi all, I am due to have my first baby in August and am totally undecided whether to book in to a private hospital at huge cost ( not insured) or take my chances in the public system. I am 49 in good health but was advised by my fertility doctor to have a caesar cos of my age. I live in a small rural town called Gympie which is an hour North of Noosa on the Sunshine Coast, QLD. THere is a 14 bed maternity section in my little local hospital in Gympie. They do NOT have a special care nursery so any probs w bub means chopper or road ambulance to the nearest regional hospital which is Nambour General Hosp. NGH has a level two nursery so any bad probs mean chopper or road to Brissie. Can someone tell me what "shared care" means? Thanks Lisa

Have you considered a home birth with a midwife? Advanced maternal age means very little in regards to "high risk" if you're healthy. It's not so much your "age" as it is your body's ability to handle the birth, and every woman's constitution is different.

When we didn't have insurance for the kind of birth I wanted, we chose to pay "out of pocket" for a midwife. Her fee was WAY less than what it would have cost us to have the baby at an "uninsured" hospital.

I'd encourage you to interview at least one midwife (preferably 2 or 3) and ask her the hard questions.

- Why is my doctor recommending a C-Section?
- What benefit would that be for me and/or my bub?
- Have you ever delivered a woman of advanced maternal age and how did the birth go?

I have a dear friend who has 7 children. She gave birth to her last baby (a homebirth) when she was 45. I remember when she conceived another child at the age of 47, and contacted her midwife. Her midwife said "this will be my first catch for a mom who's 48 years old". I'm guessing that there aren't many midwives that have the honor of assisting in a birth of a mom who is over 45 simply because natural conception declines rapidly after 40. But the interesting thing is that my friend WOULD have planned a home birth, and her midwife was all for it... and that would have been at age 48 (my friend ended up miscarrying which is very common with advanced maternal age as well).

I'm going to send Jane a message to respond to your questions because she's a wonderful midwife who frequently posts in the forums and she will be able to answer your questions with more authority. If she doesn't get back to you right away it's likely that she's attending a birth, but she will get back to you :-)

Be sure to check out the birth forum to learn more about birth choices

Thanks Kate for your quick response
No I have not considered home birth because never having had a child before,being 49 ( not as supple as I once was), and living so far away from any neonatal services. I would not want to take that risk, nor put any health professional through the worry with these circumstances.

If I was much younger, had a child before and did not live so rural, then yes, home birth would be ideal, I think it is brilliant, and I am sad I have to go to some clinical setting to go through this incredibly intimate, probably once in my lifetime experience.
Do you know what shared care means?
Thanks,
Lisa

I don't know what shared care means and I'm hoping that Jane will be able to shed some light on that.

What about using a birthing centre? Have you considered that? Or maybe using a midwife in the hospital? The public hospital may not have the midwife option, but I'd definitely ask. A birthing centre would probably give you the closest experience to a home birth and the highest chance of having no interventions and a natural birth if that's your goal. At the very least I'd look for a doctor who has a low C-Section rate (below 15% would be ideal, considering that many doctors have a 30% C-section rate (last I checked, midwives have about a 3.5% C-Cection rate - hoping Jane will correct me if this number has changed).

I'm 48 years old now and though I'm not as "spry" as I was at 40, when my last baby was born, I'd still consider a homebirth if I had the opportunity now (unfortunately I'm peri-menopausal so not much chance of having another little one).

I just did some number crunching and noticed that it seems like you're maybe at the end of your first trimester. How far along are you? Have you had any ultrasounds yet?

Thanks Kate,
Yep It is really early days just coming into week 12 and I probably am jumping the gun with my worry about where to go.
I cannot imagine any 49 yo body having a straight forward first labour. Caesar was the advice and I was relieved that it was suggested.
I am new to this area, despite being a registered nurse for the nearly three decades, I am not a midwife and all my friends birth stories are probably irrelevant due to changes over the 20 yrs since they had their children.
The birthing centre idea does sound good.
Ok thanks again
Lisa

Birth Choices

Hi Lisa,

Congratulations on nearly completing your first trimester. I'm SO excited for you!

Though it's "early days", it's actually never too early to be planning for your birth. I started planning for mine 2 years before I had my first child. If you're interested in reading about that journey, you'll find it in the "What might keep you from having a home birth" thread.

I just started a thread in the forums entitled "What are my birth choices?". I'd love to help you create the best birth experience for you in hopes that it will be all that you want it to be. This is such a special time for you and I know you're wanting to do it all as perfectly as possible for the best pregnancy and birth experience that also offers the best outcome of a precious, healthy baby.

Please take a look at that thread as it gives a link to some information on birthing centres and other options to consider.

Hi Lisa - Welcome to the forum. I am sorry I've been off-line busy with my midwifery clients. In answer to your questions about Shared Care I'll try to explain what it means. Shared care means sharing your pregnancy care between different health practitioners or a health practitioner and the hospital. The most common example of shared care in Australia is where a GP (family doctor) does the most of the pregnancy care and you have a few visits late in pregnancy at the hospital. The hospital midwives then provide the majority of care in labour (so long as no complications arise) and the care in hospital or at home in the postnatal period. You can also have shared care between say a midwife and doctor (so you may see both at different points in your pregnancy). I hope this clears this up for you.

My thoughts on whether or not to choose private or public care is to look at the advantages and disadvantages of each choice. I have a favourite technique where I suggest to client trying to make a difficult decision to get a piece of paper and draw a line down the middle and make a heading at the top of each section and then write two columns - one column the advantages and the other the disadvantages of that option. Write down everything thing you can think of. Then sit back and have a look at the big picture. This often makes the decision easier. When doing this exercise - have in the top of your mind what is really important to you for your birth.

I can see Kate and yourself have discussed homebirth and a couple of other options. Regarding the public or private option a few things to consider. Private health care in Australia has the highest intervention rates in the healthiest population. Seeing a private doctor does not necessarily mean you'll get better care. Our public health system has many innovative models available (this does depend on your local hospitals). Find out if they have caseload midwifery or team midwifery available. Choosing a continuity of care model (when one or a few known midwives follow you though your pregnancy and to be there for your birth and afterwards) is a very popular model and provides excellent and safe outcomes.

Also another option is to choose a private midwife to provide your care. Again you will be out of pocket for this option (some midwives do have Medicare eligibility though). A private midwife can not only provide homebirth care but support you for a hospital birth. You can search for private midwives close to you in Find a Practitioner search. If you are interested in this option and can find anyone in the search - let me know I will make some enquiries. Not all midwives are listed in the search

Scheduling a caesarean simply based on age is not recommendation based on research. Caesareans should only be performed for true medical indications. I've cared for a number of "older mothers" and many had a beautiful, normal and safe vaginal births. The author of Dance of the Womb Belly dance for Pregnancy and Birth DVD and Belly Dancer is pictured on the cover pregnant at 47 (and went on to have a natural birth).

Can I suggest a couple of great books to read - these may help you form your decision about what option to choose:

Thanks Jane for your comprehensive reply,
I have got quotes and that has narrowed my choice down to going purely public.
Private I am looking at around $20,000 OOP.
"Shared care" with a private obst at the general hosp is around $15,000 OOP ( includes cost of a five day stay as an intermediate pt)
Private midwife is not appropriate for my situation. I will be 50 yo two weeks after my EDD. Never given birth before and live hours away from proper neonatal medical care, I think you would agree...
Lisa

Hi Lisa - Wow - that is a lot of money out of pocket. Do you get some back from Medicare?

FYI - I personally have cared for many women considered high risk in conjunction with a public hospital (liaising with the hospital doctors) or with an obstetrician I have a collaborative relationship with. Both the midwife and the doctors work can together as your team. You can take your private midwife with you to any hospital you choose to give birth - though how a midwife can act within the hospital depends on local arrangements. I can, for instance, take a women to a tertiary referral hospital I have an arrangement with and be her midwife in the hospital. This way you can get the best of both worlds - a midwife to give you continuity of care and the best chance of a normal birth and you have access any medical care you may need (and in the case of an arrangement with both a private doctor and private midwife - you have two known experienced caregivers).

When you give birth in any hospital, either public or private, it is the hospital midwife that provides the majority of the care. If you have a private doctor, they show up just for the actual birth or if the midwife calls her or him if any complications arise in labour.